For an overview of House and Senate proposed budgets, visit our blog from February 6. 

For a spreadsheet of 2025 investments in Health Equity budget priorities across each step of the budget process, click here.  

During the pandemic, young people had access to continuous Medicaid coverage – meaning that they did not have to go through the burdensome annual redetermination of their eligibility and retained their Medicaid coverage during the public health emergency (PHE). However, in April 2023 the PHE expired and regular Medicaid renewal processes resumed, a period called ‘Medicaid Unwinding.’ After two years of falling rates during the continuous eligibility provisions, the number of uninsured children in Virginia increased from 4.4% in 2022 to 4.6% in 2023.  

More notable than the overall number of uninsured children is what you find when you dig deeper into the demographics and circumstances of the children who are uninsured. 10.3% of Hispanic or Latino children were uninsured, compared to 3.5% of non-Hispanic or Latino children in Virginia. Additionally, 6% of uninsured children in Virginia were under 200% poverty threshold – this represents about 35,000 children who are income eligible for Medicaid or FAMIS and are not enrolled, meaning that barriers to access, rather than ineligibility, are preventing them from being insured. 

There are policy levers that we can utilize to prevent more children from losing health coverage and to keep our promise to children that are covered under Medicaid to maintain enrollment as long as they remain eligible. 

Making Young People the Agenda in Health Policy During the 2025 Legislative Session 

The 2025 General Assembly regular session officially wrapped up on April 2^nd at the conclusion of reconvene session. While legislators completed their work on bills and advanced a bipartisan budget in February, the governor issued 158 vetoes and over 200 budget amendments in late March – many of which impacted our maternal health priorities.  

Virginia's General Assembly members stood strong during reconvene session and rejected the amendments that would have weakened critical maternal and infant health budget initiatives, making this legislative session one of marked progress for maternal health. On the other hand, concerns around Virginia's Medicaid budget shortfall and grave uncertainty with proposed cuts to Medicaid at the federal level meant not being able to make critical, substantive investments in policies that would strengthen our Medicaid program and ensure continuity of coverage for children – such as Cover All Kids, Continuous Medicaid Eligibility up to age 6, increasing the FAMIS income threshold, and pursuing a pathway to sustainable financing through Medicaid for Community Health Workers (CHW). 

Voices understands that children’s health is dependent on family health. That is why it is important that all children and parents have access to health care services, and insurance coverage is key to connecting them to quality, comprehensive care. 

We celebrate the progress made this session towards greater health equity and better outcomes for maternal and infant health, led by coalitions of advocates from across the commonwealth. And we remain committed to building and working alongside legislative champions who recognize the importance of proactive investments in health and well-being across the lifespan.

2025 Legislative Outcomes 

The following bills passed the General Assembly and were signed into law by the governor. These bills will go into effect on July 1, 2025:  

• SB981 (Sen. Hashmi): Annual Report on Certified Community Health Workers (CHWs) by Virginia Dept. of Health – report due November 1, 2025. 

• HB1904 (Del. Willett): Expand availability of midwives to 24-hour on-call duty rosters for newborn care. 

• HB1635 (Del. Cole)/SB1352 (Sen. Srinivasan): Alignment of practice authority for licensed certified midwives and certified nurse midwives. 

The following bills passed the General Assembly, but were amended and/or vetoed by the governor:

• HB1649 (Del. Hayes)/SB740 (Sen. Locke): Unconscious Bias and Cultural Competency Continuing Education for providers licensed by Board of Medicine 
  • Governor Youngkin recommended amendments to this bill that would have (i) removed all instances of language regarding “cultural competency” and “unconscious bias”; (ii) narrowed the provider scope to only those who work with maternal health populations; (iii) required only 2 hours of continuing learning activities; and (iv) removed reporting requirements. 
  • The General Assembly rejected the governor’s amendments, and the governor ultimately vetoed the bills. You can read his veto explanation here.

• HB1614 (Del. McClure)/SB1418 (Sen. Aird): Expands Medicaid Coverage for Doula Services 
  • Governor Youngkin recommended amendments to this bill that would have (i) replaced “birthing individual/people” with “birthing woman/women”; (ii) changed reporting entity from the legislature to the Task Force on Maternal Health Data and Quality Measures; and (iii) removed subsection vi referring to “culturally appropriate and individualized care.” 
  • The General Assembly rejected the governor’s amendments, and despite that, the governor ultimately signed the bill. The bill will go into effect July 1, 2025. 

• HB2109 (Del. Herring): Task Force on Maternal Health Data and Quality Measures 
  • Governor Youngkin recommended amendments to this bill that would have (i) removed all instances of “birthing people”; (ii) changed task force membership, including removing legislative members; and (iii) changed the sunset date from 2026 to 2028. 
  • The General Assembly rejected the governor’s amendments, and despite that, the governor ultimately signed the bill. The bill will go into effect July 1, 2025.   

Two of Voices’ priority bills did not pass the General Assembly during session:  

• HB2102 (Del. Feggans)/SB831 (Sen. Locke): Presumptive Eligibility for Pregnant Individuals  
  • HB2102 passed the House, but both bills died in the Senate Finance & Appropriations Committee. 

• SB980 (Sen. Hashmi): Medicaid Reimbursement for Community Health Workers 
  • SB980 reported from the Rules committee but died in the Senate Finance & Appropriations Committee. 

2025 Budget Outcomes

Investments in Maternal Health

• Midwife Parity in Medicaid Reimbursement: Adjusts Medicaid Reimbursement rates so that services provided by a licensed certified midwife or licensed midwife receive the same Medicaid reimbursement as a licensed physician or certified nurse midwife.
  • Governor Youngkin amended the enrolled budget, removing the funding for midwives to be reimbursed at the same rate as the physician fee schedule for covered services: Amendment 98: ($40,910); Amendment 104 ($1.25 million); and Amendment 110 ($38,244) 
  • The General Assembly rejected the governor’s amendments through the parliamentary maneuver of passing them by. 

• Pregnancy Mobile App for Medicaid members (SB1393): $159,500 GF for the Dept. of Medical Assistance Services (DMAS) to partner with a mobile pregnancy app to promote awareness of state maternal and infant health programs and information available to prenatal, pregnant, and postpartum Medicaid enrollees.  

• Perinatal Health Hub Program Pilot: $2.5 million GF for the Virginia Dept. of Health (VDH) to collaborate with the Virginia Neonatal Perinatal Collaborative (VNPC) to provide grant awards and develop a reporting structure for community-based providers to establish perinatal health hubs. 

• Maternal Mobile Health Clinic Pilot Program: Establish a pilot program for mobile clinics within maternal health deserts in Virginia.
  • Governor Youngkin amended the enrolled budget, transferring the pilot program funding from VDH to DMAS: Amendment 91 ($2.5 million) and Amendment 112 $1.25 million GF/$1.25 million NGF 
  • The General Assembly agreed to the governor’s recommendation and adopted the amendments. 

• Community Grants for Maternal Mental Health Care Programs: $500,000 GF for the Virginia Health Care Foundation (VHCF) to administer a grant program for community organizations in health care deserts to expand access to maternal mental health services. 

The following maternal health initiatives were not included in the final budget:

• Presumptive Eligibility for Pregnant Individuals: Would have directed DMAS to seek federal authority to implement presumptive eligibility for pregnant people, expediting health care coverage through Medicaid 
  • The budget includes language directing DMAS to make efforts to ensure that pregnant individuals apply for Medicaid coverage through the Cover Virginia call center to expedite coverage. 

• Billing Hub for Doulas: Would have funded Birth in Color to establish a central billing hub for doula services free of charge to doula providers working with underserved populations.  

• Remote Patient Monitoring: Would have expanded eligibility for remote patient monitoring to all pregnant and postpartum Medicaid enrollees.  

Medicaid Oversight and Systems Improvements

• Medicaid Policy Evaluation Workgroup: DMAS to establish a workgroup, comprised of staff from Dept. of Planning and Budget and House and Senate money committees, to evaluate options for developing a process that recognizes the true costs of policy changes to the Medicaid program and how to integrate that process as part of the development of the state budget. 

• Vendor Contract to Address Timely & Accurate Medicaid Eligibility Processing: $3.3 million GF/$19.1 million NGF for DMAS to contract with a vendor to implement identified solutions to assist in timely and accurate Medicaid eligibility determinations and redeterminations. 

• Efforts to Improve Medicaid Eligibility Determinations: DMAS and VDSS to (i) develop cost estimates for options proposed in the December 2024 “Evaluation for Medicaid Eligibility Determination” report and (ii) design and establish a Joint Steering Committee on Medicaid Eligibility. 

• Modifies External Financial Review Process for Medicaid: Strengthens language for requirements of external review process to monitor Medicaid expenditures and enrollment growth to determine the program's financial status. 

• Medicaid Fiscal Reporting and Transparency: Adds language requiring more detailed reporting of Medicaid expenditures monthly to the Department of Planning and Budget and the Chairs of the House and Senate money committees. Current language requires monthly expenditure reports on the Medicaid program. This language would require service level detail to be included. 

Health Care Workforce and Safety Net Services

• Federally Qualified Health Centers: $500,000 GF in FY26 to enable Federally Qualified Health Centers to continue providing comprehensive medical, dental, maternal, and mental health services to the most vulnerable and uninsured Virginians, primarily in rural and urban settings. 
  • Governor Youngkin amended the enrolled budget, reducing the funding for FQHCs by $150,000, bringing the total increased investment in FY26 to $350,000: Amendment 95 ($150,000) 
  • The General Assembly rejected the governor’s amendments through the parliamentary maneuver of passing them by. 

• Free and Charitable Clinics: $500,000 GF in FY26 to support their work of providing health care services to uninsured Virginians.  
  • Governor Youngkin amended the enrolled budget, reducing the funding for Free and Charitable Clinics by $150,000, bringing the total increased investment in FY26 to $350,000: Amendment 94 ($150,000) 
  • The General Assembly rejected the governor’s amendments through the parliamentary maneuver of passing them by. 

• Non-Emergency Medical Transportation Pilot Program: $1 million GF for the Virginia Community Healthcare Association to pilot a non-emergency medical transportation program for uninsured Virginians living in medically underserved or unserved localities in the catchment area of an FQHC. 

• LPN to RN Scholarships for School Nurses: $300,000 each year of existing nursing scholarships to be dedicated to school nurse scholarships to help school-employed Licensed Practical Nurses (LPNs) become Registered Nurses (RNs).  

• Community Health Workers and Doulas in Local Health Districts: 
  • The enrolled budget removed introduced funding and language, which added doulas to local health districts. 
  • Governor Youngkin amended the enrolled budget, restoring the funding and language that is inclusive of CHWs and Doulas: Amendment 92 $1 million GF 
  • The General Assembly rejected the governor’s amendments through the parliamentary maneuver of passing them by.  

• Tuition Assistance to Nursing Students at Hispanic-Serving Institutions: The original proposal provides tuition assistance for nursing students at Marymount University, but excludes DACA students, undocumented students, or others ineligible for federal financial aid from accessing these funds. 
  • The enrolled budget removed the governor's introduced language and funding for nursing students at Marymount University. 
  • Governor Youngkin amended the enrolled budget, restoring the funding and language to include his original proposal: Amendment 64 $1.5 million GF 
  • The General Assembly rejected the governor’s amendments through the parliamentary maneuver of passing them by. 

What’s Next? 

Voices, like many of our partners, is responding to concerns and analyzing the impacts of proposed federal funding cuts that would impact Medicaid and our health care safety net in Virginia. Despite being a state-level policy and advocacy organization, we recognize that federal funding plays a critical role in stabilizing and funding the critical services and support that help children and families thrive.  

We are fighting against significant cuts to Medicaid in the federal budget reconciliation process and advocating at the state level, urging our General Assembly members to defend Virginia’s progress on Medicaid Expansion and essential health services for young people and families.  

How can we respond at the state-level?

Virginia is one of nine states with a “trigger” law, automatically ending Medicaid Expansion coverage if federal funding drops below 90%. If that were to happen, over 630,000 Virginians would lose coverage.  

During the legislative session, lawmakers had the opportunity to include budget language, proposed by Senators Deeds and Hashmi, that directed a joint subcommittee focused on health policy to convene if federal changes to Medicaid took place. Unfortunately, the budget language was not included in the General Assembly’s enrolled budget. 

There was, however, budget language included in the enrolled budget that would require action within 30 business days from the Governor and the General Assembly if there is a reduction to federal grants by at least $100 million, and because Medicaid is a federal grant this could be used as a venue for discussions to address potential coverage loss.  

Governor Youngkin amended the enrolled budget and eliminated this language, attempting to leave us without a distinct timeline to prevent automatic coverage loss for over 630,000 Virginians if there are federal cuts to Medicaid, and instead proposed setting aside $300 million in rainy day funds at the expense of key funding priorities, including funding for schools. Fortunately, Virginia legislators rejected this amendment and are keeping the opportunities open to address the impacts of harmful federal decision-making.  

We have additional avenues to center families and young people in the decision-making process at the state-level, as the House and Senate have established committees to analyze the potential impacts that reduced federal funding will have on Virginia’s budget. Advocates can connect with the members of these committees and share the impact that Medicaid has on our lives and in our communities.  

Now is the time for us to share our stories about how important Medicaid is for us and for communities. Join us in telling Congressional Representatives to prioritize Virginia’s children and families in funding decisions and to oppose any efforts to reduce federal funding for Medicaid or implement administrative barriers to coverage.

Take Action Now to Protect Medicaid!

Click the image above to take action today!

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